The treatment/rehabilitation article that I critiqued was called “Effectivenss of Rehabilitation for patients with subacromial impingement syndrome (evidence-based practice)” from the Journal of Athletic Training. It asks the question “What is the best treatment method for patients with subacromial impingement syndrome (SAIS)?” SAIS refers to the painful and ROM-inhibiting pain in the subacromial space during humerus flexion. It is also particularly detrimental to an athlete because it can lead to rotator cuff damage and biceps tendonitis.
This article actually was a compilation of dozens of SAIS studies performed up until 2003 and treatment results were combined and analyzed in a new way by the authors of this article. Treatments were divided into 6 different categories: therapeutic exercise, joint mobilization, ultrasound, acupuncture, laser, and a group that received no useful treatment (placebo). Point values were determined by the lab’s principle investigators to judge the effectiveness of each treatment. From their results, therapeutic exercise was very beneficial in both the short and long term although it was even more effective when combined with joint mobilizations. Laser proved to only be effective when compared to the placebo group and did not increase the improvements due to therapeutic exercise. From the results, this article concluded that the use of acupuncture and ultrasound is not very effective instead of or in accordance with a therapeutic exercise program.
I think that overall this article helps give therapeutic exercise the legitimacy it deserves for its effectiveness in treating various orthopedic conditions non-surgically. By strengthening, stretching, and improving proprioception in the shoulder and surrounding musculature and improving blood flow, many conditions can be treated at least partially and some signs and symptoms alleviated. The research results encouraging use of joint mobilization makes sense for this type of injury treatment as well because rest and decreased subacromial compression will most likely help reduce the inflammation to the area and secondary damage. I found it interesting that the use of acupuncture, lasers, and ultrasound were not very effective for treatment of this injury.
Some of the problems with this article include the use of treatment studies from decades ago. Only current research within the past 5-10 years should have been used to come to the conclusions that the authors of this article did. Also, I feel that this article should have also tested the efficacy of other therapeutic modalities such as ice, E-stim, or the surgical approach of subacromial decompression. Besides these issues, I would take the conclusions of this article as support for therapeutic exercise and joint mobilizations in the integrated approach to injury treatment.